Risk assessment of late complications after robotic radical cystectomy with total intracorporeal urinary diversion
INTRODUCTION AND OBJECTIVES: Robotic radical cystectomy (RRC) with intracorporeal urinary diversion (UD) is a challenging procedure with a high rate of perioperative complications. In this study we assessed the risk of late complications after RRC with intracorporeal UD.
METHODS: From October 2012 to October 2014, 100 consecutive unselected patients with cT2-4a/cN1-3/cM0 bladder cancer underwent RRC, extended lymphadenectomy and totally intracorporeal UD. Baseline demographics, perioperative and follow up data were prospectively collected. Univariable and multivariable regression analysis were performed to identify independent predictors of surgery related (SR) and any kind of late complications at six-mo evaluation.
RESULTS: Out of 100 RRC, we selected 87 consecutive patients with a minimum 6-mo follow up. Sixty-nine patients received a Padua Ileal bladder (54 male and 15 female), while 18 patients received an ileal conduit. At a six-mo follow up 60 (68.9%) patients experienced any kind of late complication, 49 (56.4%) were SR.
Ortotopic UD, preoperative eGFR and learning curve were significant predictors of SR complication at univariable analysis (p=0.032, p=0.042 and p=0.05, respectively). At multivariable analysis, the only independent predictor of surgical related late
complications was orthotopic UD (p = 0.010; HR: 5.01 [95% CI, 1.47–17.04]).
Learning curve and preoperative eGFR were significant predictors of any complications at univariable analysis (p= 0.008, andp=0.044, respectively). At multivariable analysis, the only independent predictor of any kind of late complications was the learning curve (p = 0.025; HR: 0.97 [95% CI, 0.95–0.99]).
CONCLUSIONS: RRC with intracorporeal neobladder is feasible but associated to higher risks of SR complications at six-mo evaluation. Learning curve plays a key role for a stepwise reduction of perioperative complications.